nursing

Denise Tiran is a midwife, lecturer, complementary practitioner and an international authority on maternity complementary medicine. In her new book, The Business of Maternity Care, she offers advice and guidance for midwives and doulas who want to establish a maternity-related business, offering services such as pregnancy complementary therapies, antenatal classes, lactation support or full doula care. Read an extract below in which Denise discusses why more people are looking to set up their own businesses in this field.

Midwives working in the NHS are increasingly disillusioned with the care they are able to provide for women (discussions with numerous midwives on courses, at conferences, by telephone and on social media). Many feel that the demands of midwifery practice today do not meet the ideals that caused them to enter the profession in the first place. The workload is phenomenal, with a risk-averse dependence on physio-pathological monitoring and the prevention or management of complications. Midwives have little time or energy to provide the psycho-emotional and social support that is so much a part of holistic maternity care. Continue reading →

In this extract from Complementary Therapies for Older People in Care, Sharon Tay gives practical advice on how therapists can adapt treatments to suit older people with age-related medical conditions, such as Arthritis, Parkinson’s Disease and Cardiovascular Disease.

Sharon demonstrates how the role of a beauty and natural therapist is valuable in providing care and attention to frail and elderly people who can no longer cater for their own needs. Simple treatments such as an application of make-up, a session of reflexology or a manicure can greatly restore dignity and confidence to help these clients face the challenges in their physical and mental well-being that ageing brings.

Sharon Tay is a beauty therapist and natural therapist who has worked in the industry for eighteen years. She specialises in health and beauty care for women of all age groups, particularly with older women residing in both nursing homes and private residences. Complementary Therapies for Older People in Care is available to purchase from the Singing Dragon website.

Cynthia W. Quarta has taught martial arts for over twenty five years and was the Activities Director at an assisted living facility. She continues to teach seated Tai Chi classes in a number of locations to a range of ages and levels of physical fitness. She lives in Great Falls, Montana, USA.

Can you tell us a bit about yourself and how you came to practice martial arts in the first place?

I saw my first martial arts demonstration (jujitsu) when I was nine years old. I wasn’t able to take lessons, however, until many years later when one of my advanced ballet students asked to be excused from classes so she could take her black belt test. That was the first I had heard about her involvement in the martial arts. I offered to barter dance lessons in exchange for instruction in her style of Korean karate (Kwon Bup) to which she agreed. Shortly after that she began teaching several other classes in which I also participated. I finally received my black belt and, after my sensei moved out of town, opened my own dojo. Throughout the succeeding years, I had the opportunity to study Eagle Dragon Chinese Kenpo Kung Fu as well as a smattering of WuShu and Tae Kwon Do.

What motivated you to write this book, and what is it about generally?

While I was working as the Activities Director at a local retirement community, I used my dance and martial arts background to design an exercise program for the residents. When the community changed from one for able-bodied retirees to an assisted living facility for those with limited physical mobility, I had to change my approach. With the help of a core group of resident fitness enthusiasts, I developed a program of seated exercises based on the Yang style of T’ai Chi Chuan and the energizing exercises of Qigong.

This book presents a series of seated exercises to benefit people of all ages and levels of fitness. It is written for therapists and caregivers who want to provide an alternative, effective and creative approach to healing. The book includes instructions specifically for these health care professionals to assist them in their work with their patients/clients.

Why do the Tai Chi and Qigong exercises you’ve adapted in the book lend themselves so well to being practiced in a chair?

Both Tai Chi and Qigong are gentle exercise systems that provide healing and increase overall wellness. Regardless of a person’s situation – whether they are recovering from surgery, recently injured, elderly, or dealing with a chronic disability – these exercises are safe and yet amazingly effective. The emphasis in these exercises is on proper breathing and the involvement of the mind in the process of reducing stress, increasing energy and improving oxygen levels. For that reason the practitioner need not be in top physical condition or, for that matter, even able to stand in order to reap the benefits from the use of these exercises.

What positive effects can professionals hope to see in their clients and patients as a result of using the exercises?

The professional who uses this system with his/her patients will see immediate results in stress reduction, increased oxygen levels, improved appetite, more restful sleep, and a decrease in pain and stiffness. Mayo Clinic, Harvard Medical School and a number of other medical facilities with research divisions have published studies on the benefits of regular Tai Chi and Qigong practice. I encourage any health care professional considering whether or not to try this program to research these studies (most of them are conveniently available online).

Are there any common obstacles that professionals face when trying to guide their clients/patients through the exercise? How can this book help?

The primary challenge is the lack of knowledge and familiarity. Most of us in Western countries haven’t been exposed to Eastern medicine to any great extent. Overcoming the resistance to a new, holistic approach to improved health is usually the biggest obstacle at the beginning. As time goes on, though, and as patients begin to experience the benefits, their attitudes will change. This book contains a basic but inclusive explanation of Chinese medical theories to help professionals explain to their patients why these types of exercises can improve anyone’s level of health.

Why is it important to include a chapter on self-care for the professional?

If there is anyone who needs help in managing stress and achieving balance in their busy lives it is those who labor daily with patients who are ill or disabled! Therapists must be both relaxed and balanced in all areas of their lives if they are to help others achieve their wellness goals.

How does the book reflect your general philosophy about health?

I believe that an exercise program that works in combination with a healthy lifestyle and a well-balanced body, mind and spirit is the secret to a long and vigorous life. The exercises described in my book are gentle and safe and because they are designed to be practiced while seated, they provide a program that can be used daily even by those with physical limitations or of advanced age. In other words, this exercise system can be used throughout one’s life from youth through middle age and on into the later years, while at peak physical condition or at a stage of life when diminished mobility and strength present a daily challenge.

Can you tell us a bit about the paths that led you to massage therapy, and to its applications in integrative health and palliative care?

I was a homecare nurse and wanted to offer therapy that would be comforting to my patients in ways that nursing did not routinely provide care. While massage therapy is within the scope of practice for nurses, I did not feel prepared to perform massage effectively, especially with patients who had chronic and terminal illness. I decided to go to the Swedish Institute of Massage Therapy and my interest in incorporating massage into nursing practice came from there. There are multiple studies that show the beneficial effect of massage therapy on the symptoms associated with disease, so I believe massage can be utilized as a symptom management technique. This is very useful in palliative and hospice care where multiple therapies, treatments and modalities are used to alleviate the distress that patients experience.

How did the new book come about, and what is it about, generally?

Barbara asked me to join her in writing this book as she had developed the hand massage protocol and implemented it in a nursing home. My expertise in hospice and palliative care and perspective on providing comfort for patients through multiple avenues resulted in a wonderful collaboration with this book. We both had an interest in providing ways for caregivers to help and to feel that their efforts are effective in providing comfort, so teaching hand massage to caregivers is a great opportunity to change not only the patient’s experience, but also the caregiver’s experience too.

How does the book reflect your general philosophy about care?

I believe that caring for any person who is ill begins with compassion which can be delivered in many ways. Touch is one of the most fundamental ways to offer support and caring and is often underestimated or disregarded in healthcare settings. Touch is often mechanistic and task oriented, so teaching healthcare practitioners to incorporate hand massage redirects their actions to that of a caring activity, which also has an affect on their perspective on helping to “heal”. A hand massage is a wonderful, easy introduction to using touch. From a caregiver’s perspective, they often feel disconnected from the person who is ill or weary of touching them, so it’s a wonderful way to approach the ill person and provide care in a manner that is satisfying to the ill person and to the caregiver, and safe. The hands are the most logical place to start as it often is the first place that we touch when communicating with and meeting people for the first time.

What are the benefits of touch as a way of connecting with people, as opposed to other methods of communication?

Touch can convey so many things that other forms of communication do not. Touch can be directed in many ways. It can have a calming effect or a stimulating effect that can be tailored to the goals of the touch experience. The hands are one of the easiest ways to approach someone; merely by shaking hands, you can have a dramatic effect. Touch can be more powerful than other forms of communication especially when someone is sick. Touch directed in a caring way can have more meaning than words, which makes it a useful tool when teaching caregivers to express through touch what they cannot often express through words.

What are some common obstacles people encounter when trying to use hand massage?

Caregivers often feel inadequate or unprepared to do massage. They have fears of being awkward or ineffective. They are not sure if they are doing it right. The beauty though, is that any touch whether awkward or not, can positively influence the giver and receiver. People often have difficulty slowing down and paying attention to energetic influences. This also comes with practice, so people need encouragement to keep practicing and over time, how they feel about the massage will change.

How can the book help caregivers overcome this and other obstacles?

This book touches on many areas that most people do not think about, especially from an energetic perspective and from an eastern approach to touch. It teaches people about the simplicity of touch and how it can have a dramatic effect. We hope that the framework in the hand massage protocol allows people to take the first step towards incorporating massage into their everyday caregiving.

This book can be used as a guide to doing a hand massage protocol. We encourage caregivers to have the book with them when doing massage, so that they can reference the steps and view the illustrations. It can also be used as a teaching tool in a classroom setting.

What are some examples of best practice?

Best practices always put the receiver’s needs first. Safety and comfort are a priority, so the giver must ensure the receiver is not suffering or in distress before performing massage. We also encourage caregivers to discuss the use of massage with the healthcare team to obtain permission, but also to find out if there are cautions and contraindications to massage. Because the receivers often have significant illness, it’s always best to err on the side of caution and pay attention to the receivers reaction to massage. This is truly a client-centered approach. And lastly, don’t take it too seriously. Massage should be light-hearted and friendly, an experience to be enjoyed not just by the receiver, but by the giver too.

My passion for integrative health care began 30 years ago, when I travelled to California to recuperate from a car accident. I was a seeker, looking for solace and a new path. Southern California offered warmth, reasonable rents, and ways of living that seemed open to many possibilities. It was commonplace there to focus on fitness, and easy to find gyms, yoga teachers, health food stores, and book shops filled with Eastern philosophy and self-help. Then there was the Pacific Ocean, like a big glittering mirror, reflecting who you were and at the same time inviting you to look deeper.

This was all very different from life in New York City at the time, where a focus on fitness was not so commonplace. In fact, friends on the East Coast often looked down on some of these pursuits. They’d ask, ‘Why is California like a breakfast cereal?’ Answer: Because it’s full of fruits, flakes and nuts! Maybe they thought it was foolish, but I felt I was finally becoming sensible.

During my seven years in Los Angles I completed my bachelor’s degree at UCLA, but my most meaningful studies were outside of traditional academia. I explored ‘alternative’ therapies, as they were called back then, because they were not part of the mainstream. Fortunately, I found reliable teachers who were masters in their field. I practiced yoga every day in Bikram Choudhury’s classes. Thanks to Jack Gray, whose energy work was studied by Dr. Thelma Moss at UCLA’s Parapsychology Lab, I learned how to direct my thoughts to help the healing process and to use my hands to do what Mr. Gray called ‘transfer of energy’. Dr. Grace Brunler demonstrated how she had used color light in her medical practice with her husband Oscar Brunler. With Jon Hofferman, a grad student from the UCLA film department, we made a short documentary about her work.

It was an exciting time, because it felt like a real movement in personal well-being was taking place. It wasn’t being led by doctors, but by ordinary people who were looking for more than symptom relief. They wanted therapies that were natural and non-toxic, and a way to be involved in the healing process. That was a key—becoming an active participant in wellness and illness instead of being a passive recipient of care. The quest for ways to be involved in the healing process, and for tangible ways to share it, became the continuing thread of my studies, writing and teaching.

When I moved back to New York City I wondered if I would be able to maintain the gentle practices I’d learned. As it turned out, I discovered deeper and more specific ways of practicing. With Catherine Shainberg, director of the School of Images, I studied body-centered imagery for many years. Dr. Shainberg doesn’t give answers, but leads students to the answers within themselves. My sessions with her led me to study massage therapy at the Swedish Institute, a college of health sciences in Manhattan. This allowed me to go from just writing about this field to becoming a practitioner.

After working for a few years as a licensed massage therapist, a desire for a more effective ways to engage with the body led me to Jeffrey C. Yuen and the study of Chinese medicine. I began to understand that energy, or Qi, infuses all of life, and that it is fundamental. Qi is our energetic program; it creates the body and directs our growth, development and everyday processes, including healing.

While I appreciate that there exists some controversy around the idea of Qi—it has no standard definition, it’s not readily visible, and can’t be quantified—I embrace its usefulness as teachers and practitioners have done through the ages. Directing Qi through the use of meridian points became the foundation of my practice, which often included teaching people to move their Qi from within through imagery.

Today, ‘alternative’ therapies are not just for Californians and even in New York City there are plenty of gyms, as well as stores selling organic food. Yoga, massage, meditation and acupuncture are now part of an integrative approach to cancer care, palliative care or chronic conditions in medical institutions around the world.

Comforting Touch for Dementia and End of Life Care: Take My Hand, is an integrative approach that will hopefully inspire people to explore touch as a way to share the radiant energy of their care. I was fortunate to have as co-author Niamh van Meines, who brought in her expertise and passion as a massage therapist and nurse practitioner working in hospice and palliative care. In the book, we introduce people to the idea that their touch involves the physical aspects of skin, muscles and bone; the energies of warmth, electromagnetism and Qi; and the inner quality, or spirit, which they bring to it. All will have beneficial effects for both the giver as well as the receiver. And in the spirit of integrative care, we encourage caregivers to become part of a team—whether with a doctor, nurse, social worker, psychologist, massage therapist, acupuncturist or pastoral advisor—so they will not feel alone, inhibited by initial awkwardness, or unnecessarily fearful.

I was happy when our book proposal was accepted by Jessica Kingsley Publishers, because they are so dedicated to the healing arts and to books that people can use to help one another. When Lisa Clark, our sponsoring editor, told us we would be part of the Singing Dragon imprint, it seemed especially fitting, because the energy of nature and the Eastern philosophy that teaches ways to engage with it have been a big part of my life. I hope that this book will be useful for the many people caring for someone with dementia or at the end of life, and that it will provide a meaningful way to discover both a tenderness and a power that we all have in common.

Edeltraud Rohnfeld qualified as a yoga teacher at the Berlin Yoga Institute Asha Rekai in 1991. She taught private yoga classes in Berlin for 15 years and trained yoga teachers and healthcare professionals. She later specialised in chair yoga, learning from its founder Erika Hammerstroem. She moved to Ireland in 2008 where she runs seminars on chair and classic yoga.

What drew you to yoga, and how did you develop an interest in the seated form?

When I was 22 my sister showed me my first yoga exercises. I had just returned from a six-month trip to Israel feeling a little confused and without a clear perspective. I had reached a point where I was wondering what I should do with my life. Discovering yoga helped me not only physically, but emotionally too. Every time I did yoga something beautiful happened in me. It was different than doing sport. Not only my body benefited, but my mind and my soul as well. I began to feel more stable and gained more clarity in this very uncertain period of my life. I became more focused and was able to be more aware of all the possibilities life had to offer me. I practised yoga for years and undertook numerous courses. As I became more knowledgeable, I began to practice yoga with small groups of friends and it gave me such a pleasure that I then decided to become a Yoga Instructor.

Two years after completing my education in 1993, I met Erika Hammerstroem – the founder of Chair Yoga. She was an experienced Yoga Instructor who felt a strong need to aid group members who sometimes found it impossible to continue classes due to physical, aging-related limitations. Not wishing them to be excluded from participating in their much loved yoga classes, she began to adapt and devise exercises based on the classic form of yoga but using a chair instead of a mat. The interest in the classes was so great that she then went on to educate the Instructors so they could go on to teach classes. I was one of her students and I began to take my own chair classes in addition to mat yoga.

I began to develop more exercises as my experience grew. I wanted to share as much knowledge as I could and, realising the interest was so great, I decided to write a book about it. Erika Hammerstroem loved the idea. Sadly, she passed away in 2004 at the tender age of 82, just a few months before my book was published in german. I dedicated my book to her and to the angel to whom we prayed together.

I have been teaching both Classic and Chair Yoga for the last 17 years, and I get great pleasure from teaching anyone who loves yoga. My hope for the future is that Chair Yoga will be practised more widely throughout the world, allowing yoga to become more accessible to people who previously thought they could not do it, and to offer my seminars to Yoga Instructors all over the world.

What are the key benefits of practising Chair Yoga?

The key benefits of Chair Yoga are very similar to those of Classic Yoga. The only difference is that the risk of injury is significantly reduced on the chair. The whole body is moved and becomes more supple. Movements incorporate the spine, and all muscles and inner organs get gently stretched and strengthened (including the heart). The exercises support circulation, enabling better oxygenation to all the cells of the body, to the digestive system and to the immune system. It helps to reduce and cope with stress, anxiety and insomnia and increases self-esteem. By practising Chair Yoga frequently, one can feel more balanced in life and it can enable you to have more joy in life whilst becoming more flexible.

How does the book reflect your general philosophy about health and wellbeing?

In my opinion health and wellbeing is about finding a balance between one’s physical and psychological needs. By undertaking yoga frequently, one can improve and maintain good flexibility and strengthen muscles. Combining this with a good balanced diet, sufficient rest and regularly practising relaxation techniques, one can achieve good physical wellbeing.

The body and mind are strongly linked; if the body feels healthier, the mind will feel clearer and calmer and perhaps more receptive and better able to deal with the challenges in life. People need to have more self-awareness of their individual needs. Yoga empowers people to be more able to focus on their individual needs and not to give in to negative influences.

There is a strong connection between people feeling emotionally stressed and experiencing physical symptoms. Rather than trying to suppress worries and fears, yoga helps people confront their anxieties instead of ignoring them. This in turn can help us become emotionally strong and empowered. It has certainly helped me to find my way through difficult periods in my life, and to have faith and be more accepting of the things that I cannot control.

With my book I want to encourage everybody who is interested in practicing yoga to take their life in their own hands and make the best out of it. Despite any physical or psychological limitations, you can still practice Chair Yoga and significantly improve your health and wellbeing.

Why was it important to include a section about diet?

Whilst practising yoga greatly improves one’s health and wellbeing, in order to achieve the maximum benefits one needs to eat healthy too. A student who smokes, drinks alcohol and eats “junk food” will not gain as much from yoga as an individual who does not.

Throughout my years teaching yoga I’ve met many people who are not well-informed about how to make healthier dietary choices – for example choosing to eat “whole” foods as opposed to refined foods. Additionally I’ve had many students who were unaware of the importance of drinking water frequently while practising yoga. Yoga helps the body excrete accumulated toxins. With enough water the body is able to flush out these toxins; failure to drink enough water can result in headaches and joint and generalised pain throughout the body.

It was critical for me to inform my readers of the role diet and nutrition play in complementing yoga and in improving one’s health.

However, as I discuss in my book, it is not necessary for the individual to be vegetarian or a non-smoker in order to practice yoga. Awareness and understanding may enable students to begin to gradually change and alter their eating, drinking or smoking habits. It is important for people to achieve this in their own individual way. Many of us acquire bad habits over a period of years and therefore changes must be made slowly and at a realistic pace. Yoga is not about pressure or force and every person must respond to their own goals at their own pace.

How should this book be used?

First and foremost, I would recommend that the reader examine the Introduction and exercises. Try a few exercises which may be of particular interest or proceed to “Chapter 13: Exercise Guidelines” and start with a 15-minute program.

Depending on how you find the program, extend it to a 30-minute program in the next session. Try not to over-do the sessions. Instead, give yourself small realistic goals such as 2-3 times a week for 15 minutes, and aim to continue this at regular intervals. As you feel more and more able, increase first the length of each session and then the frequency.

Remember never to force yourself to do yoga, but practise it with joy!